Newborn Hearing Screening
South Africa has forms of systematic screening program for neonatal hearing loss. In the private sector, programs commenced in hospitals such as Netcare and with a national screening initiatives launched in 2019 in the private sector. In the public sector, some facilities have started screening through National Health Insurance (NHI) pilot hearing screening but these are not systemative. Approximately 85% of healthcare services are delivered through the public sector, with 15% through the private sector. It is estimated that less than 10% of newborns are screened in South Africa.
Presbycusis
No formal early detection program for presbycusis exists in South Africa. Detection of presbycusis generally occurs through routine audiometric evaluations and screenings conducted by audiologists in both public and private healthcare settings. Audiologists typically do screening or nurses where audiologist manage the screening program. ENTs can also screen and so can GPs. Given the healthcare split, the majority of services are provided through the public sector, with private sector offerings available for those with insurance or the ability to pay out-of-pocket. There is hospital advertisement about presbycusis but not broader than that.
Patient and healthcare professional pathways
The audiology care pathway in South Africa involves multiple key players. Audiologists are responsible for conducting audiometric tests, diagnosing hearing issues, and providing rehabilitation, including fitting and adjusting hearing aids. ENT specialists handle the medical and surgical management of ear-related conditions, including cochlear implant surgery, while audiologist assist in the fitting and maintenance of hearing aids and cochlear implants. It is an organization similar to models in the United States or Australia, etc.
Reimbursement
In the public sector, hearing aids (as well as their fitting and the follow-up) are provided free of charge apart from a minimal administrative fee, with adults typically receiving one hearing aid. However, waiting lists can be very long – from 4 months to 3 years ; it varies from hospitals and across provinces and regions – and points of access for services may be difficult to access due to transport and distance issues but also the limited number of audiologists in the public sector. As a result, the hearing aid penetration rate is 6-10%. Cochlear implants are not covered by the public healthcare system at the moment. In the private sector, nsurance coverage varies, with private insurance plans offering partial coverage for hearing aids and cochlear implants. Patients often incur significant out-of-pocket expenses, especially for higher-end devices. A medical prescription is not needed for hearing aids.
Quality of care
Provision of audiological care in South Africa is currently insufficient. There is a shortage of audiologists, with only 947 registered audiologists in the country. There are also insufficient ENT specialists and clinics to meet the demand for services like cochlear implants. Access to services is significantly better in urban areas compared to rural ones, which are underserved. Most audiologists work in private practice, leaving public sector services limited.
Access to higher education is limited due to socio-economic barriers and training capacity is currently full. More training programs would be needed.
Téléaudiologie
Teleaudiology is authorized to be utilized in South Africa. It is not widely used but increasingly services are being explore at various points in the treatment process, including screening and diagnostics including through mHealth solutions, as well as follow-up and rehabilitation, where remote fitting and adjustment of hearing aids are done using smartphone-based applications and other teleaudiology tools. Both the public sector and private sector are using some teleaudiology, though private sector adoption might be more advanced due to better resources.
